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Hip joint replacement
Definition
Hip joint replacement is surgery to replace all or part of the hip joint with a man-made (artificial) joint. The artificial joint is called a prosthesis.
Alternative Names
Hip arthroplasty; Total hip replacement; Hip hemiarthroplasty
Description
Your hip joint is made up of two major parts. One or both parts may be replaced during surgery:
- The hip socket (a part of the pelvic bone called the acetabulum)
- The upper end of the thighbone (called the femoral head)
The new hip that replaces the old one is made up of these parts:
- A socket, which is usually made of strong metal
- A liner, which fits inside the socket. It is usually plastic, but some surgeons are now trying other materials, like ceramic and metal. The liner allows the hip to move smoothly.
- A metal or ceramic ball that will replace the round head (top) of your thigh bone.
- A metal stem that is attached to the thigh bone to make the joint more stable.
You will not feel any pain during surgery because you will have one of two types of anesthesia:
- General anesthesia. This means you will be asleep and unable to feel pain.
- Regional (spinal or epidural anesthesia). Medicine is put into your back to make you numb below your waist. You will also get medicine to make you sleepy. And you may get medicine that will make you forget about the procedure, even though you will not be fully asleep.
After you receive anesthesia, your surgeon will make a surgical cut to open up your hip joint. Often this cut is over the buttocks. Then your surgeon will:
- Cut and remove the head of your thigh bone
- Clean out your hip socket and remove the rest of the cartilage and damaged or arthritic bone
- Put the new hip socket in place, then insert the metal stem into your thigh bone
- Place the correct-sized ball for the new joint
- Secure all of the new parts in place, sometimes with a special cement
- Repair the muscles and tendons around the new joint
- Close the surgical cut
This surgery usually takes 1 to 3 hours.
Why the Procedure Is Performed
The most common reason to have a hip joint replaced is to relieve severe arthritis pain that is limiting your activities.
Hip joint replacement is usually done in people age 60 and older, but many people who have this surgery are younger. Younger people who have a hip replaced may put extra stress on the artificial hip. That extra stress can cause it to wear out. Part or all of the joint may need to be replaced again if that happens.
Your doctor may recommend a hip replacement for these problems:
- You can't sleep through the night because of hip pain
- Your hip pain has not gotten better with other treatments
- Hip pain limits or prevents you from doing your normal activities, such as bathing, preparing meals, doing household chores, and walking
Other reasons for replacing the hip joint are:
- Fractures in the thigh bone. Older adults often have a hip replacement for this reason.
- Hip joint tumors
See also: Deciding to have knee or hip replacement
Risks
Risks for any anesthesia are:
- Allergic reactions to medicines
- Breathing problems
Risks for any surgery are:
- Bleeding
- Blood clots in the legs that may travel to the lungs
- Heart attack or stroke during surgery
- Infection, including in the lungs, urinary tract, and chest
For more detail about joint replacement, see also: Risks of hip and knee replacement
Before the Procedure
Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
During the 2 weeks before your surgery:
- Prepare your home.
- Two weeks before surgery you may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs.
- You may also need to stop taking medicine that can make you more likely to get an infection. This includes methotrexate, Enbrel, and other medicines that suppress your immune system.
- Ask your doctor which drugs you should still take on the day of your surgery.
- If you have diabetes, heart disease, or other medical conditions, your surgeon will ask you to see the doctor who treats you for these conditions.
- Tell your doctor if you have been drinking a lot of alcohol, more than 1 or 2 drinks a day.
- If you smoke, you need to stop. Ask your doctor or nurse for help. Smoking will slow down wound and bone healing.
- Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you have before your surgery.
- You may want to visit a physical therapist to learn some exercises to do before surgery and to practice using crutches or a walker.
- Set up your home to make everyday tasks easier
Practice using a cane, walker, crutches, or wheelchair correctly to:
- Get in and out of the shower
- Go up and down stairs
- Sit down to use the toilet and stand up after using the toilet
- Use the shower chair
On the day of your surgery:
- You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure.
- Take the drugs your doctor told you to take with a small sip of water.
See also: The night before your surgery, orthopedic
Your doctor or nurse will tell you when to arrive at the hospital.
See also: Blood donation before surgery
After the Procedure
You will stay in the hospital for 2 - 3 days. During that time you will recover from your anesthesia, and from the surgery itself. You will be asked to start moving and walking as soon as the first day after surgery.
Some people need a short stay in a rehabilitation center after they leave the hospital and before they go home. At a rehab center, you will learn how to safely do your daily activities on your own. Home health services are also available.
For more information, see also:
- Hip or knee replacement - in the hospital after
- Hip replacement discharge
- Taking care of your new hip
Outlook (Prognosis)
Hip replacement surgery results are usually excellent. Most or all of your pain and stiffness should go away.
Some people may have problems with infection, loosening, or even dislocation of the new hip joint.
Over time -- sometimes as long as 15 - 20 years -- the artificial hip joint will loosen. You may need a second replacement.
Younger, more active people may wear out parts of their new hip. It may need to be replaced before the artificial hip loosens.
References
Eikelboom JW, Karthikeyan G, Fagel N, Hirsh J. American Association of Orthopaedic Surgeons and American College of Chest Physicians guidelines for venous thromboembolism prevention in hip and knee arthroplasty differ: what are the implications for clinicians and patients? Chest. 2009;135:513-520.
Harkess JW. Arthroplasty of the hip. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 7.
Jones CA. Total joint arthroplasties: current concepts of patient outcomes after surgery. Rheum Dis Clin North Am. 2007;33(1):71-86.
St Clair SF. Hip and knee arthroplasty in the geriatric population. Clin Geriatr Med. 2006;22(3): 515-533.
Schmalzried TP. Metal-metal bearing surfaces in hip arthroplasty. Orthopedics. 2009;32.
Lindstrom D, Sadr Azodi O, Wladis A, et al. Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial. Ann Surg. 2008;248:739-745.
Reviewed By: A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery (9/22/2011).
